Introduction: Poor dental hygiene has been associated with various perinatal complications in studiesdone worldwide but few studies in Nepal have explored the knowledge of pregnant ladies regardingdental hygiene. The aim of the study was to know the knowledge and practices of pregnant womenregarding oral health in a tertiary care center in Nepal. Methods: A qualitative study was carried out in Nobel Medical College and Teaching Hospital fromJanuary 15, 2018 to June 15, 2018 after approval from the Institutional Review Committee of NobelMedical College. Convenience sampling was done. Fifty pregnant women admitted in antenatalward were interviewed regarding their knowledge of dental care in pregnancy, the common dentalproblems they faced and the treatment taken. A predesigned proforma was used and results wereanalyzed using SPSS version 17. Results: Twenty two (44%) patients reported dental problems during pregnancy. Bleeding gumswas seen in 7 (14%) and toothache in 7 (14%) were commonly reported dental problems. Forty seven(94%) patients acknowledged that routine dental care was needed for health, only 6 (12%) wereaware that poor dental health could affect baby weight. Oral health not seen as priority in 24 (48%)was the main barrier to seeking dental care in pregnancy followed by costs of treatment in 18 (36%)and safety concerns in pregnancy in 8 (16%) cases. Conclusions: Though dental problems were a common occurrence in pregnancy, utilization ofservices was low for the same. The participants reported significant barriers to obtaining dental careincluding lack of knowledge about the importance of maternal oral health and the treatment costs.

Introduction: Infertility is a global health issue and a socially destabilizing condition for couples with several stigmas including medical, social, psychological burdens and a marital disharmony. The aim was to study the incidence of infertility in couples attending outdoor of Nobel Medical College and to know the contributing factors among the infertile couples.Methods: A prospective cross-sectional study was carried out in the outpatient department of a teaching hospital July 2015-June 2016, where the incidence of infertility and the contributing factors for the same were evaluated.Results: The incidence of infertility in this study was 5.45% and it was dominated by secondary infertility. The most important cause was male factor in 37.39%. Majority of male factor abnormality was due to exposure to heat as these male work abroad in Arabian Countries.Conclusions: The study shows a dominance of secondary infertility and male factor being a major contributor. The most common semen abnormality was oligospermia. Keywords: infertility; incidence; oligospermia; semen. | PubMed

Background Intrahepatic cholestasis of pregnancy has poor feto-maternal outcomes. To date there has been sparse publications regarding impact of intrahepatic cholestasis in feto-maternal outcomes in our setting. Therefore, we aimed to study the feto-maternal outcome in patients with intrahepatic cholestasis of pregnancy.Material and Methods A hospital based prospective cross-sectional study carried out in department of Obstetrics and Gynecology of Nobel Medical College, Biratnagar, Nepal from 1st January 2014 to 30th December 2015 in women who presented with pruritus in third trimester of pregnancy and having deranged liver function tests. All the cases were followed from admission to discharge. Socio-demographic, clinico-laboratory profile and feto-maternal outcomes were recorded in a preformed structured proforma. Descriptive statistics was used to present the data.Results Among 6,780 women admitted for delivery, 80 had cholestasis of pregnancy with incidence of 1.15%. 83% were of 18-35 years and 65% were primigravida. Most distressing symptom was generalized pruritus (75.0 %). The cesarean delivery rate was 46.25% and labor induction rate was (47.5%). Fetal complications were seen in majority of cases that included meconium aspiration syndrome 26 (32.5%), intrapartum fetal distress 21 (26.25%) and requirement of: intensive care 38 (48.75%). There were 7 perinatal and 3 neonatal deaths.Conclusion Intrahepatic cholestasis of pregnancy seems fairly common among pregnant women. It may be responsible for a large number of perinatal and neonatal deaths especially after 36 weeks of gestation. A large prospective study is needed to address the problems in time.Journal of Nobel Medical College Volume 5, Number 1, Issue 8, January-July 2016, 20-25

Background & Objectives: Post cesarean surgical site infection (SSI) is one of the commonly encountered complications which considerably increase the burden to health care. It is caused due to the interplay of various patient related, procedure related and iatrogenic factors. This study aims at identifying common risk factors for post cesarean SSI at our centre. Materials & Methods: This was a prospective observational study conducted from July 2015 to December 2015, in which all patients who were admitted with post cesarean SSI or developed SSI during their stay were included and their risk factors were studied. Results: Emergency procedures (82.97%) were more likely to develop SSI as compared to elective cesarean (17%). Among the patient related risk factors most of them were nulliparous (48.9%), term gestation (42.6%), malnourished (53.1%) and had history of prolonged leaking (44.68%) The mean age was 24.04±4.6years.Most of the patients who developed SSI were operated for repeat cesarean and fetal indications. Most patients who had SSI had at three to five per vaginal examinations (2.72±2). 66% of patient who had SSI had duration of surgery more than one hour. 68% of the surgeries which developed SSI were done by residents as compared to 32% of those done by consultants Conclusion: The commonly associated risk factors linked with post cesarean SSI are maternal age, emergency procedures, prolonged membrane rupture, multiple vaginal examinations, malnutrition and the experience of surgeon. 3,4,6 One of the patient related factors is young maternal age as most of the infections (92%) occurred in women less than thirty years of age, this is in accordance with other studies. 7,8 Hypertensive disorders in pregnancy which is linked with chronic alteration in peripheral blood supply have been found to a risk factor for SSI.9, 10 In this study 27.7% of patients with SSI suffered from this condition. Both obesity and malnutrition have been associated with increased risk of SSI. 7,8 The association of obesity with SSI could be due to relative avascularity of adipose tissue and hence poor healing, difficulty in handling of tissues and hence more chance of micro-trauma and also failure in obliteration of dead spaces. Likewise malnutrition can lead to SSI due to poor healing of tissues and decreased immunity. In our study population malnutrition was a more common risk factor (53.1%) as compared to obesity (14.9%) and it is a reflection of the general population characteristic of our part of the world where most childbearing women are anemic and malnourished. Prolonged rupture of membrane (>8hrs) are established risk factors of SSI. 3,6,11 Even in the present study they were found to be significantly associated with SSI with prolonged PROM in 44.5% of patients and most patients with more than three per vaginal examinations. Loss of protective cervical mucus plug and barrier effect of fetal membranes and amniotic fluid after rupture of membranes are thought to be the culprits. The more the vaginal examinations the m...

Introduction: Post cesarean surgical site infection (SSI) is one of the common complications diagnosed in 2.5%-16% of the cases and is associated with significant increase in maternal morbidity, hospital stay, costs, and psychological stress to the new parents. This study was designed to study the incidence of SSI and the antimicrobial resistance pattern in our hospital.   Methods: This was a prospective observational study conducted from July 2015 to December 2015, in which all patients who were admitted with post cesarean SSI or developed SSI during their stay were included.  Wound specimens were collected and susceptibility testing was carried out using disc diffusion technique.   Results: The incidence of post cesarean SSI was 6.07% (47/774). Out of the 47 patients who had SSI, 35 (74.75%) had positive swab culture. The most important organism isolated was Staphylococcus aureus (82.85%) out of which 17 (58.62%) were MRSA strain. The resistance of Staphylococcus to penicillin was 84.6% whereas amikacin was found to be highly sensitive (>96%). Among the MRSA strain, resistance to ciprofloxacin, which is the currently used drug for prophylaxis, was 94%. Resistance to penicillins, cephalosporins, and clavulanate was also high. Resistance to vancomycin was also high (53%). Amikacin and chloramphenicol were found to be highly sensitive  (94% and 90% respectively) in the MRSA group.   Conclusion: MRSA is the leading cause of post cesarean SSI and is a matter of great concern. Amikacin and chloramphenicol were found to be highly sensitive in this group but unlike other studies, resistance of vancomycin was showing an increasing trend.